ACTIVITY REQUIREMENTS

Name: ORQUINA, BERNARD L. Date: DECEMBER 10, 2020 Group No. 2

Area: ONCOLOGY DEPARTMENT C.I: Prof. CESARLICA MINGUITA, MN, RN
Case: ICU CASE STUDY

General Objectives (5pts):

At the end of this case study, I would be able to understand the concept on how to
deliver standard care or management to a patient with poorly managed diabetes mellitus
type 2.

Specific activities (10pts):

                 
Learn:
K the normal values of blood glucose against hyperglycemia;
the signs and symptoms of DM;
the types of insulin used to manage DM;

Learn the routes and sites for insulin administration;

S Identify nursing interventions to a patient with DM type 2.

A Develop appropriate attitude in caring to a patient with DM.

Daily Plan of Activities

(10 pts)
TIME ACTIVITIES
Thursday Download the case study material from the google virtual
7:00 AM – 12:00 PM classroom; begin researching relevant materials that explain how
to perform nursing assessment to patients with DM type 2
disease; materials that identify normal values and its deviations
of blood glucose; the types of insulin used; routes and sites for
insulin administration.
Make the KSA, DPA, Data Base and history of the patient, nursing
system review chart, nursing assessment, pathophysiology,
diagnostics and doctor’s order
Friday Continue making the drug study, nursing care plans, nurse’s
7:00 AM – 12:00 PM notes, health teachings, learning feedback diary, journal reading,
and case conclusion

Score:           /25
 DATA BASE AND HISTORY
Name of Client: JOHN DOE Sex: MALE   Age: 52 YEARS OLD  Religion: NOT SPECIFIED
Civil Status: N/A Income: N/A Nationality: N/A
Pulse Rate: _____________  Resp. Rate: ____________ BP: __________Height_____________ Weight: _______________

Chief Complaint and History of Present Illness:

High fever, headache, and right sided facial swelling.

Poorly managed diabetic mellitus type 2.

Type of Previous Date Type of Previous Date

Illness/ Illness

Pregnancy/Delivery Pregnancy/Delivery

DM TYPE 2

Has received blood in the past: N/A Yes ___ No. If yes, list dates _____Reactions: ___Yes ___ No

Medication Dose/ Time of Medication Name Dose/ Time of Last 

Name Last 
Frequency Frequency Dose
Dose

Insulin IV DVT prophylaxis

Meropenem Posaconazole 200mg TDS
Teicoplanin Deferiprone 1500mg TDS
Iatraconazole Amphotericin 3-5mg/kg
Were you admitted?_________Yes _________No If Yes, where?_____________________

Attending Physician: NOT SPECIFIED

Score:           /20

NURSING SYSTEM REVIEW CHART

Name of Client: JOHN DOE Sex: MALE   Age: 52 YEARS OLD 
Vital Signs: Pulse ________ BP __________ Temp. _______ Resp. _______ Height ______ Weight ________

INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate
the location of the problem in the figure using [X].
EENT
[ X ] impaired vision [  ] blind               [  ] drainage __________________________
[  ] gum infection [  ] difficulty of hearing[  ] deaf __________________________
[  ] burning [ X ] edema [  ] lesion teeth __________________________
[  ] no problem [  ] others __________________________
RESPIRATION   
[  ] asymmetric [  ] tachypnea [  ] barrel chest__________________________
[  ] apnea [  ] rales [  ] cough            __________________________
[  ] bradypnea [  ] shallow [  ] rhonchi __________________________
[  ] sputum [  ] diminished [  ] dyspnea __________________________
[  ] orthopnea [  ] labored [  ] wheezing __________________________
[] pain [  ] cyanotic [  ] no problem __________________________
[  ] others __________________________
GASTROINTESTINAL TRACT
[  ] obese [  ] distention [  ] mass __________________________
[  ] dysphagia [  ] rigidity [  ] pain __________________________
[  ] abnormal bowel habits [  ] bowel sounds __________________________
[  ] no problem [  ] others __________________________
GENITO-URINARY AND GYNE
[  ] pain [  ] urine color [  ] vaginal bleeding __________________________
[  ] hematuria [  ] nocturia [  ] odor __________________________
[  ] gyne bleeding [  ] no problem [  ] others _________________________
NEURO
[  ] paralysis [  ] stuporous [  ] unsteady [  ] seizures __________________________
[  ] lethargic [  ] comatose [  ] vertigo [  ] tremors __________________________
[  ] confused [  ] vision [  ] grip [  ] no problem __________________________
[  ] others __________________________
MUSCULOSKELETAL AND SKIN
[  ] appliance [  ] stiffness [  ] itching [  ] petechiae __________________________
[ X ] hot [  ] drainage [  ] prosthesis [X  ] swelling __________________________
[  ] lesion [  ] poor turgor [  ] cool [  ] flushed __________________________
[  ] atrophy [X  ] pain [  ] ecchymosis [  ] diaphoretic moist __________________________
* assess mobility, motion, gait, alignment, joint function _________________________
   skin color, texture, turgor, integrity [  ] no problem __________________________
NOTE: Tender maxillary and frontal sinuses

Score:           /20

NURSING ASSESSMENT
 SUBJECTIVE OBJECTIVE
COMMUNICATION: [  ]Glasses                   [  ] Languages            
]Hearing loss           Comments: _____________ [  ]Contact lens          [  ] Hearing aid
[X  ]Visual changes              ___________________       R                                  L
[  ]Denied                             _____________________ Pupil Size _______  
                                    ______________________ Speech Difficulties_________
Reaction _____________________________
OXYGENATION: Respiration :            [  ] regular       [ X ] irregular
[  ]Dyspnea           Comments: ________________ Describe: _________________________________
[  ]Smoking history     ________________________ _________________________________
                                         _________________________
[  ]Cough                       _________________________ R ____________________________________
[  ]Sputum                    _________________________ L ____________________________________
[  ]Denied                     _________________________
CIRCULATION: Heart Rhythm        [  ] regular        [  ] irregular
[  ] Chest pain          Comments: ______________ Ankle Edema   ________ Heart_____________
[  ] Leg pain                __________________________         Carotid     Radial     Dorsal Pedis     Femoral
[  ] Numbness of       __________________________    R ____________________________________
     Extremities           __________________________ L_____________________________________
[  ] Denied                   __________________________ Comments: ____________________________
                                       __________________________     *If Applicable __________________________
                           
NUTRITION:
Diet: _____________________________________ [  ] Dentures              [  ] None
[  ]  N              [  ]  V    Comments: _____________          
         Character                  ______________________                       Full          Partial           
[  ] Recent change          _______________________  Upper           [  ]              [  ]                      
[  ] Weight, appetite      _______________________ Lower            [  ]              [  ]                    
[  ] Swallowing               _______________________
     Difficulty                     _______________________
[  ] Denied                        _______________________   
ELIMINATION: Comments: _________   Bowel Sounds ______
[  ] Usual bowel pattern     [  ] Urinary ______________________________________
frequency ___________________  Abdominal Distention
___________________     ___________________ ___________________  Present   [  ] Yes [  ] No
[  ] Constipation                   [  ] Urgency ___________________  Urine * (color,                 
      Remedies                               [  ] Dyspnea                                              consistency, odor)
___________________             [  ] Hematuria ___________________  *if foley bag  catheter         
      Date of last BM              [  ] Incontinence                                                is in place
___________________            [  ] Polyturia
[  ] Diarrhea                                 [  ] Foley in
place
     Character _________           [  ] Denied
*MGT. OF HEALTH & ILLNESS Briefly describe the patient’s ability to follow
[  ] Alcohol                           [  ] Denied treatments (diet, medication, etc.) for chronic
(Amount, frequency) health problems (if present)
SBE last pap smear ________________________ __________________________________________________________
LMP ____________________________________ __________________
  SUBJECTIVE OBJECTIVE
SKIN INTEGRITY: [  ]Dry                  [  ]Cold                  [  ] Pale         
 [ ] Dry                           Comments: ____________ [  ]Flushed          [  ] Warm  
[  ]Itching                           ______________________ [  ] Moist             [  ] Cyanotic
[  ]Others                           ______________________ *Rashes, ulcers, decubitus (Describe size, location,
[  ] Denied                         ______________________ drainage)_____________________________
                                             ______________________ _____________________________________
                                             ______________________ _____________________________________
ACTIVITY/SAFETY:  LOC and Orientation  ___________________
[  ]Convulsion         Comments: ______________ _____________________________________
                                        _________________________ [  ] Gait       [  ] Walker     [  ] Care         [  ] Other
[  ]Dizziness                 _________________________ [  ] Steady                                  [  ] Unsteady
                                        _________________________ Sensory and motor losses in face or extremities
[  ]Limited motion     _______________________ _____________________________________
    Of joints            _____________________________________
Limitation of  ability to  [  ] ROM limitations _____________________
[  ] Ambulate             _________________________ _____________________________________
[  ] Bathe itself          _________________________ _____________________________________
[  ] Other                    _________________________
[  ] Denied                 _________________________
COMFORT/SLEEP/AWAKE
[  ] Pain                Comments: ________________ [  ] Facial grimaces
(Location, frequency    ______________________ [  ] Guarding
 Remedies)                __________________________ [  ] Other signs of pain ___________________
[  ] Nocturia              __________________________ ______________________________________
[  ] Sleep difficulties   _______________________ [  ] Side rail release form signed (60+ years)
[  ] Denied                 __________________________ ______________________________________
                                     __________________________ ______________________________________
COPING:
Occupation ______________________________ Observed non-verbal behaviour ___________
Members of the household _________________ ______________________________________
Most Supportive Person ____________________ ______________________________________
Person (Phone Number) __________________
______________________________________

   Score:           /50

Patient’s Name: JOHN DOE Diagnosis: Ineffective peripheral tissue perfusion

ILLUSTRATIONS/TRACING OF THE PATHOPHYSIOLOGY OF THE DISEASE

Reference:https://nurseslabs.com/diabetes-mellitus/

Score:           /20
Patient’s Name: JOHN DOE Diagnosis: Ineffective peripheral tissue perfusion

DIAGNOSTIC EXAMS

DIAGNOSTIC TEST W/ RESULT INTERPRETATIO SIGNIFICANCE NURSING REMARKS

NORMAL VALUES N RESPONSIBILIT
Y
CBC
TC 33780
Neutrophils 93% High
HB 4.8
Cr 3.9 Very high
CRP 217
CBG >500 Diabetic
CXR Clear Clear
ABG Not Acidotic,
Urinary Ketones
Absent
Iron Studies Ferritin 2354 Very high
Se Fe 20
TIBC 180
ANA ANCA
negative
Serum No monoclonal
electrophoresis bands
MRI -Cervico medullary junction appears Changes of
normal supratenorial
-right maxillary sinus is completely parenchymal
occupied or obliterated by atrophy observed
hyperintense mucosal thickening and which is quite
fluid collection here probably of acute unusual for a given
sinusitis. Similar changes patchily also age needs attention.
DIAGNOSTIC TEST W/ RESULT INTERPRETATIO SIGNIFICANCE NURSING REMARKS
NORMAL VALUES N RESPONSIBILIT
Y
observed involving the bilateral Supratentorial white
ethmoidal air cells, right sphenoid and matter ischaemic
right frontal sinus with partial changes also
peripheral involvement of the left observed.
maxillary sinus as well. -Multiple scattered
-illdefined hypointensities noted in the resolved foci of old
left sphenoid sinus probably of irregular
inspissitated thick secretions or fungal heterogenous farct
colonization. having irregular
cystic change and
maginal gliosis seen
in left peritrigonal
white matter, left
perithird ventricular
white matter region,
posteroinferiorly in
the left putamen, in
the right side of
pons at the junction
of anterior two third
and posterior third
with foci in the right
thalamus
posteroinferiorly as
mentioned.
Illdefined local
linear heterogenous
gliotic ci to the right
of midline
observedinvolving
 DIAGNOSTIC TEST W/ RESULT INTERPRETATIO SIGNIFICANCE NURSING REMARKS
NORMAL VALUES N RESPONSIBILIT
Y
the vermis.
CT scan of NCCT PNS and orbit
sinuses and reveals:
orbit -right maxillary sinus is
completely opacified
with soft tissue and
thick mucosal
thickening noted in the
left maxillary, bilateral
ethmoid, bilateral
sphenoid and frontal
sinus suggestive of
chronic sinusitis.
-Both osteomeatal units
are blocked with soft
tissue.
-pneumatisation of left
sided anterior clenoid
process seen
-minimal deviation of
anterior nasal septum to
the left observed.
-right sided eyelid and
medial canthus appears
mildly thickened likely
inflammatory changes
Score:           /20
Patient’s Name: John Doe Diagnosis:

SUMMARY OF DOCTOR’S ORDER

DATE DOCTORS ORDER RATIONALE

Not specified >IVF and intravenous insulin infusion For the high level of blood
sugar with CBG >500
>Meropenem and Teicoplanin For infection
>Antifungal cover initially with Fungal infection
Iatraconazole.
>DVT prophylaxis For edema noted in right face
>Posaconazole 200mgTDS Fungal infection
>Iron chelation therapy with Deferiprone To lower high level of Ferritin
1500mg TDS. that was 2354ug/L
Score:           /20
 DRUG STUDY
Name Date  Classificati Dose/ Mechanism  Specific Contra- Side Effects/ Nursing
of Ordere on Frequen Of Action Indication Indication Toxic Effects Precaution
Drug d cy (Why drug is
Generi Ordered)
c 
(Bran
d)
Meropenem Antibiotic Bactericidal: For serious Hypersensitivity Diarrhoea, nausea, vomiting, abdominal pain; headache; Assess patient
inhibits infectionscaus tomeropenem constipation; rash, pruritus, urticaria; apnoea; phlebitis, for previous
synthesis of ed by gram- or imipenem. thrombophlebitis, swelling and painat inj site; sensitivity
bacterial cell positive or   disturbances in L reaction to
wall and gram- FTs (may cause increases in serum transaminases, carbapenems
causes cell negative alkalinephosphatase, lacticdehydrogenase). Assess patient
death. organisms Rarely: erythema for signs and
  multiforme;eosinophilia,thrombocytopenia,leucopenia,ne symptoms
utropenia; seizures and CNS effects reported inpatients of infection,
with underlying CNS disorders or renal impairment. including
characteristics
of wounds,
sputum, urine,
stool
Complete C/S
tests before
beginning drug
therapy
Assess for
allergic
reactions,
anaphylaxis
Identify urine
output
Monitor blood
Name Date  Classificati Dose/ Mechanism  Specific Contra- Side Effects/ Nursing
of Ordere on Frequen Of Action Indication Indication Toxic Effects Precaution
Drug d cy (Why drug is
Generi Ordered)
c 
(Bran
d)
studies
Monitor electroly
tes
Assess bowel
pattern daily
Monitor
for bleeding
Precautions:
Pregnancy,
lactation, renal
disease, elderly

Iatraconazole Antifungal Itraconazole is indicated for Should not be Adverse events infrequently reported in all studies You should not
agent a highly the treatment administered for included constipation, gastritis, depression, take this
selective of the the treatment of insomnia, tinnitus, menstrual disorder, adrenal medicine if you
inhibitor of following onychomycosis insufficiency, gynecomastia, and male breast pain. have ever
fungal fungal in patients with had heart failure.
cytochrome P- infections: evidence of
450 sterol C- Aspergillosis, ventricular If you have liver
14 α- pulmonary dysfunction such or kidney
demethylation and extra- as congestive disease, you
via the pulmonary, in heart failure should not take
inhibition of patients who (CHF) or a itraconazole
the enzyme are intolerant history of CHF.  with colchicine,
cytochrome of or who are fesoterodine, or
P450 14α- refractory to solifenacin.
demethylase. amphotericin
Name Date  Classificati Dose/ Mechanism  Specific Contra- Side Effects/ Nursing
of Ordere on Frequen Of Action Indication Indication Toxic Effects Precaution
Drug d cy (Why drug is
Generi Ordered)
c 
(Bran
d)
This enzyme B therapy.
converts Itraconazole may
lanosterol to harm an unborn
ergosterol, and baby. Avoid getti
is required in ng
fungal cell pregnant while
wall synthesis. taking
itraconazole and
for 2 months
after your last
dose.

Stop using
itraconazole and
call your doctor
at once if you
have signs of
congestive heart
failure: feeling
tired or short of
breath, cough
with mucus, fast
heartbeats,
swelling, rapid
weight gain, or
sleep problems.
Name Date  Classificati Dose/ Mechanism  Specific Contra- Side Effects/ Nursing
of Ordere on Frequen Of Action Indication Indication Toxic Effects Precaution
Drug d cy (Why drug is
Generi Ordered)
c 
(Bran
d)

Life-threatening
side effects may
occur if you take
itraconazole with
certain other
drugs. Tell your
doctor about all
your current
medicines and
any you start or
stop using.

Deferiprone Iron Deferiprone is Indicated for Deferiprone is The most common side effects include nausea, vomiting, Take with or
chelator an iron the treatment contraindicated stomach-area (abdominal) pain, joint pain without food.
chelator that of patients in patients with Food does not
binds to ferric with a hypersensitivit affect absorption.
ions (iron III) transfusional y to deferiprone
and forms a iron overload or any excipients Interrupt therapy
3:1 due to in the if neutropenia
(deferiprone:ir thalassemia formulation.  develops
on) stable syndromes
complex and is when current Interrupt therapy
then chelation if infection
eliminated in therapy is develops
the urine. inadequate.
 Name Date  Classificati Dose/ Mechanism  Specific Contra- Side Effects/ Nursing
of Ordere on Frequen Of Action Indication Indication Toxic Effects Precaution
Drug d cy (Why drug is
Generi Ordered)
c 
(Bran
d)
Deferiprone is
more selective
for iron in
which other
metals such as
zinc, copper,
and aluminum
have a lower
affinity for
deferiprone.

Score:           /20

NURSING CARE PLAN

Diagnosis:Ineffective peripheral tissue perfusion related to too much glucose in the bloodstream

 Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
Ineffective peripheral At the end of nursing Assess for signs of Hyperglycemia results
HbA1c -12.8 tissue interventions, patient hyperglycemia. when there is an
perfusion related to has a blood glucose inadequate amount of
too much glucose in the reading of less than insulin to glucose.
bloodstream 180 mg/dL; fasting Excess glucose in the
blood glucose levels of blood creates an
less than <140 mg/dL; osmotic effect that
hemoglobin A1C level results in increased
<7%. thirst, hunger, and
increased urination.
The patient may also
report nonspecific
symptoms
of fatigue and blurred
vision.

Assess blood glucose levels Blood glucose should

before meals and at be between 140 to 180
bedtime. mg/dL. Non-intensive
care patients should be
maintained at pre-meal
levels <140 mg/dL.

Monitor the patient’s HbA1c- This is a measure of

glycosylated hemoglobin.  blood glucose over the
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
previous 2 to 3 months.
A level of 6.5% to 7% is
desirable.

Weight daily.  To help assess the

adequacy of nutritional
intake. 
Assess for anxiety, tremors, These are signs of
and slurring of speech. Treat hypoglycemia and D50
hypoglycemia with 50% is the treatment for it
dextrose.
Assess feet for temperature, To monitor peripheral
pulses, color, and sensation.perfusion and
neuropathy.
Assess bowel sounds by Hyperglycemia disrupts
auscultation and note any gastric motility in
reports of abdominal pain, the stomach,
bloating, nausea or vomiting duodenum, and
.  jejunum and may affect
choice of interventions.
Monitor urine albumin to Renal failure causes
serum creatinine for renal creatinine >1.5 mg/dL.
failure. Microalbuminuria is the
first sign of diabetic
nephropathy.
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
Assess the pattern of Physical activity helps
physical activity. lower blood glucose
levels. Regular exercise
is a core part of
diabetes management
and reduces risk for
cardiovascular
complications.

Monitor for signs of A patient with type 2

hypoglycemia. diabetes who uses
insulin as part of the
treatment plan is at
increased risk for
hypoglycemia.
Manifestations of
hypoglycemia may vary
among individuals but
are consistent in the
same individual. The
signs of hypoglycemia
are the result of both
increased adrenergic
activity and decreased
glucose delivery to the
brain, therefore, the
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
patient may experience:
changes in LOC,
tachycardia,
diaphoresis, dizziness,
headache, fatigue, cold
and clammy skin,
hunger, shakiness, and
visual changes.

Watch out for signs of Morning hyperglycemia,

morning hyperglycemia. as the name suggests,
is an elevated blood
glucose level arising in
the morning due to
insufficient level of
insulin. Causes include
the
dawn phenomenon (no
rmal blood glucose
levels until 3 AM then
levels begin to rise),
insulin waning
(progressive increase in
glucose levels from
bedtime to morning),
and Somogyi effect
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
(nocturnal
hypoglycemia then
rebound
hyperglycemia).

Teach patient how to Blood glucose is

perform home glucose monitored before
monitoring. meals and at bedtime.
Glucose values are
used to adjust insulin
doses.

Score:           /20

NURSING CARE PLAN

Diagnosis: Risk for Infection

Cues Nursing Objective Intervention Rationale Evaluation

Diagnosis
H/O high Risk for infection Identify Monitor for the signs of Early diagnosis and treatment of
fever, interventions to infection and infections can control their severity
headache,
prevent/reduce risk inflammation: fever, and decreases complications. Patients
and right
sided facial of infection. flushed appearance, with diabetes may be admitted with
swelling, wound drainage, purulent infection, which could have
tender Demonstrate sputum, cloudy urine. precipitated the ketoacidotic state.
maxillary techniques, lifestyle They may also develop nosocomial
and frontal changes to prevent infection.
sinuses development of
infection.

Auscultate breath Rhonchi may indicate accumulation of

sounds. secretions possibly related
to pneumonia or bronchitis. Crackles
may results from pulmonary
congestion or edema from rapid fluid
replacement or heart failure.

Teach and promote Hand hygiene is the single most

good hand hygiene. effective way in preventing the
transmission of diseases. Include the
patient’s SO in teaching.
Maintain asepsis during Increased glucose in the blood creates
IV insertion, an excellent medium for immune
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
administration of dysfunction and for pathogens to
medications, and thrive.
providing wound or site
care. Rotate IV sites as
indicated.
Provide catheter or Urinary tract infections are more
perineal care. Teach prevalent in individuals with diabetes.
female patients to clean Diabetes is a predisposing factor for
from front to back after vaginitis, poor perineal hygiene
elimination. increases the risk of vaginitis and can
spread through the urinary tract
causing infection.
 Provide meticulous skin An impairment or ineffective
care by gently massaging peripheral circulation can place the
bony areas, keep skin dry. patient at risk for increased skin
Keep linens dry and breakdown and development of
wrinkle-free. infection.

Encourage increase in Increase fluid intake to approximately

fluid intake unless 3,000 mL per day to increase urinary
contraindicated. flow and prevent stasis of urine which
Encourage intake of may increase susceptibility to
cranberry juice per day as infection (i.e., urinary tract infection).
appropriate. Regular intake of cranberry juice can
help in inhibiting the adhesion of
pathogens to the bladder wall and
Cues Nursing Objective Intervention Rationale Evaluation
Diagnosis
impairing the colonization.

Administer antibiotics as Early treatment may help

indicated. prevent sepsis as patients with
diabetes are more prone to serious
infectious diseases. 

Recommend obtaining Streptococcus pneumonia and influen

vaccines, as indicated. za virus are the most frequent
respiratory infections associated with
persons with diabetes. They are six
times more likely to need
hospitalizations during influenza
epidemics than non-diabetic patients.
Anti-pneumococcal and influenza
vaccines are recommended.

Score:           /20
 HEALTH TEACHINGS
Name of Client:JOHN DOE

Take your medicine as prescribed. If you have unpleasant side effects,

MEDICATIONS contact your healthcare provider.

Exercise regularly. A balanced program of exercise and rest can help keep
your blood sugar level stable. Check your blood sugar level before and
EXERCISE after exercise. Always carry a carbohydrate snack (like crackers) to eat if
you feel weak.
Diabetes can dry out your skin. That means you could get injured more
easily, be more likely to get an infection, and take longer to heal. When
you bathe or shower, use warm water, and a mild, moisturizing soap.
After washing and drying off, use a mild lotion to prevent dry skin. Avoid
TREATMENT scratching dry skin, apply moisturizer instead.

Protect your skin. Inspect your skin daily for dryness, cuts, redness, or
any changes. Drink plenty of water (unless your healthcare provider
wants you to limit fluids).
OUT PATIENT Check your feet. Because diabetes may damage nerves in your feet, you
(Check-up) may not feel small cuts and bruises. Check your feet every day for sores.
If you feel any numbness, tingling, or burning in your feet, contact your
healthcare provider immediately. Wear comfortable shoes that fit
properly and never go barefoot.
Monitor blood glucose and learn how to interpret and appropriately
respond to the results.
Diabetes mellitus ( DM ) is one of the leading cause of kidney failure in
the United States. Approximately one-half of people who need dialysis
have kidney disease from diabetes.With that, tight control of blood sugar
must be done by avoiding concentrated sweets and high-carbohydrate
content foods.Diabetic patients with hypertension have a special lower
blood pressure target of less than 130 / 80 mmHg to reduce
cardiovascular risk and delay progression of kidney disease.

Change your diet. Your healthcare provider and a nutritionist can help
you plan meals that are low in fat, salt, sugar, and cholesterol. Cut
calories if you're overweight. Limit your alcohol intake.
DIET To control your blood glucose level, you must have healthy eating habits.
A healthy diet has other benefits too. Healthy eating can lead to weight
loss. Losing small amounts of weight can often make a big difference in
your health. Healthy eating can improve your blood glucose, blood
pressure, and cholesterol levels.

Stop smoking. Besides raising your blood sugar level, smoking also
damages your heart and kidneys.
Take care of your teeth. People with diabetes have a higher risk of
cavities and gum disease. Have regular checkups, brush after every meal,
and floss daily.

Score:           /20
Patient’s Name: JOHN DOE

Diagnosis: Ineffective tissue perfusion

NURSE’S NOTES

DATE/ TIME DAR

SHIFT
FEBRUAR 7AM - D- Received patient c complains of high fever, R sided facial
Y 10, 2020 swelling, and reported headache two days prior to admission.
A-Assessed patient’s vital signs, elevated temperature at 39C,
tachycardic, and cold clammy skin.
-Tepid sponge bath provided, facilitated change of clothing for
comfort, administered medication for fever per doctor’s order.
R-Patient’s temperature lowered at 37C.
A--Seen by Doctor Z and carried out doctor;s order.
-Endorsed to ICU.

Score:           /20
 LEARNING FEEDBACKDIARY
LEARNINGS FEELINGS PROBLEMS MET SOLUTIONS REMARKS
Self Learned to be self- Exhausted Anxious to beat the deadlines Make time to finish all
sufficient in doing things in making the case studies these.
like this.

Activity The activity is very good if Exhausted Cramming cause we have other Make time to finish all
we have been given ample things to do that need attention these.
time to finish them all. too.

Case/Topic Learned nursing Exhausted The materials are heavy to take Make extra time to digest
management on patient in. them all
with diabetes mellitus type
2

Clinical Instructor The CI has provided very Exhausted The materials are heavy to take Make extra time to digest
good materials for special in without further assistance them all
areas that we need to be from learned professionals.
exposed to.

Score:           /20
 JOURNAL READING
Loneliness and type 2 diabetes incidence:
findings from the English Longitudinal
Study of Ageing
 Ruth A. Hackett, 
 Joanna L. Hudson & 
 Joseph Chilcot 

Diabetologia volume 63, pages2329–2338(2020)
Abstract

Aims/hypothesis
Loneliness is associated with all-cause mortality and coronary heart disease.
However, the prospective relationship between loneliness and type 2 diabetes
onset is unclear.

Methods
We conducted a longitudinal observational population study with data on 4112
diabetes-free participants (mean age 65.02 ± 9.05) from the English
Longitudinal Study of Ageing. Loneliness was assessed in 2004–2005 using
the revised University of California, Los Angeles (UCLA) Loneliness Scale.
Incident type 2 diabetes cases were assessed from 2006 to 2017. Associations
were modelled using Cox proportional hazards regression, adjusting for
potential confounders, which included cardiometabolic comorbidities.

Results
A total of 264 (6.42%) participants developed type 2 diabetes over the follow-
up period. Loneliness was a significant predictor of incident type 2 diabetes
(HR 1.46; 95% CI 1.15, 1.84; p = 0.002) independent of age, sex, ethnicity,
wealth, smoking status, physical activity, alcohol consumption, BMI, HbA 1c,
hypertension and cardiovascular disease. Further analyses detected an
association between loneliness and type 2 diabetes onset (HR 1.41; 95% CI
1.04, 1.90; p = 0.027), independent of depressive symptoms, living alone and
social isolation. Living alone and social isolation were not significantly
associated with type 2 diabetes onset.

Conclusions/interpretation
Loneliness is a risk factor for type 2 diabetes. The mechanisms underlying this
relationship remain to be elucidated.
INSIGHTS/ REACTION:

I am today years old to have learned that loneliness is a risk factor for type 2 diabetes. I
have come to realize that it is really important to have a sunny disposition in life whatever
storms and strong winds that may come and try to darken our sun. However, it all depends
on every one. Loneliness as a factor for a disease such as diabetes is a sad thing to learn.
Type 2 Diabetes comes at a later age where people begin to lose a loved one, may have lost
a job, may have failed in a business venture, bouts of depression, etc. Loneliness has been
all around us. Learning the risk factors of a disease like this comes handy now so that we
can begin shielding ourselves from this situation.

Score:        /25
 CASE CONCLUSION:
(minimum of 250 words)

A 50-year old male patient was presented to the ER with complains of high fever, headache and
right sided facial swelling. Upon clinical investigations, the patient was noted to have developed
sepsis with pyrexia, was hypotensive and tachycardic. Diagnostics were found that the patient
has poorly managed Type 2 Diabetes with HbA1c result of 12.8%, that was a lot higher than the
normal limits of 5.7 – 6.4%; CBGs of >500; but chest and abdominal examinations grossly
normal. Further investigations confirmed sepsis and with the above normal value of Creatinine of
3.9, the patient must need immediate intensive care. Elevated creatinine means that the kidney
has malfunctioned or impaired. The persistent capillary blood glucose of >500 has contributed to
the presentation of symptoms upon admission is an emergency as this can shoot up to the
dangerous diabetic coma when the CBG goes up to 600mg/dL where the patient can become
very dehydrated. The iron chelation therapy was ordered because of the high level of Ferritin in
the blood which has shot up to 2354ug/L from the normal limit of 400ug/L.

Score:           /20